Massive Pneumoperitoneum after Bronchoscopy and Noninvasive Ventilation in a COVID-19 Patient, without Associated Pneumomediastinum or Pneumothorax
Maria Tudela, Maria Fernandez
Citation Information :
Tudela M, Fernandez M. Massive Pneumoperitoneum after Bronchoscopy and Noninvasive Ventilation in a COVID-19 Patient, without Associated Pneumomediastinum or Pneumothorax. Panam J Trauma Crit Care Emerg Surg 2020; 9 (2):162-164.
The most common cause of pneumoperitoneum is a perforated hollow viscus. However, there are other causes that have been termed nonsurgical, asymptomatic, benign, or idiopathic pneumoperitoneum, most of them of thoracic origin; these are due to complications caused by invasive mechanical ventilation or interventional procedures such as fiberoptic bronchoscopy and are accompanied by pneumomediastinum, pneumothorax, or both. We present a case of isolated massive pneumoperitoneum, without accompanying pneumothorax or pneumomediastinum, in a patient with bilateral bronchopneumonia due to coronavirus disease 2019 (COVID-19) already cured and who underwent urgent bronchoscopy due to hemoptysis. This is a rather exceptional case due to barotrauma after noninvasive ventilation, and in whose pathophysiological mechanism both bronchoscopy and possible pulmonary fibrosis resulting from bilateral COVID-19 pneumonia may also have played a role.
Mularski RA, Sippel JM, Osborne ML. Pneumoperitoneum: a review of nonsurgical causes. Crit Care Med 2000;28(7):2638–2644. DOI: 10.1097/00003246-200007000-00078.
Okamoto A, Nakao A, Matsuda K, et al. Non-surgical pneumoperitoneum associated with mechanical ventilation. Acute Med Surg 2014;1(4):254–255. DOI: 10.1002/ams2.52.
Planchard D, Verdaguer M, Levrat V, et al. Pneumoperitoneum and pneumomediastinum complicating non-invasive ventilation. Rev Mal Respir 2005;22(1):147–150. DOI: 10.1016/s0761-8425(05) 85446-4.
Olgemoller U, Korber W, Criee CP. Abdominal free air without signs of perforated abdominal viscus during non-invasive ventilation. Dtsch Med Wochenschr 2012;137(31-32):1591–1594. DOI: 10.1055/s-0032-1305183.
Wolfromm A, Weiss N, Espinoza S, et al. Non-invasive positive pressure ventilation (NIPPV)-induced pneumocephalus and pneumoperitoneum in a patient with a one-way flow control ventriculoperitoneal shunt. Intensive Care Med 2011;37(5):889–890. DOI: 10.1007/s00134-011-2191-7.
Vélez Silva R, Martínez Jiménez CH, Fernández Hurtado I. Neumoperitoneo como complicación de la ventilación mecánica, sin evidencia radiológica de neumotórax. Emergencias 2006;18:170–173.
Stahl DL, Richard KM, Papadimos TJ. Complications of bronchoscopy: a concise synopsis. Int J Crit Illn Inj Sci 2015;5(3):189–195. DOI: 10.4103/2229-5151.164995.
Venkataraman T, Frieman MB. The role of epidermal growth factor receptor (EGFR) signaling in SARS coronavirus-induced pulmonary fibrosis. Antiviral Res 2017;143:142–150. DOI: 10.1016/j.antiviral.2017.03.022.
Wahidi MM, Lamb C, Murgu S, et al. American association for bronchology and interventional pulmonology (AABIP) statement on the use of bronchoscopy and respiratory specimen collection in patients with suspected or confirmed COVID-19 infection. J Bronchology Interv Pulmonol 2020. DOI: 10.1097/LBR.0000000000000681.
García-Santos E, Puerto-Puerto A, Sánchez-García S, et al. Síndrome compartimental abdominal por neumoperitoneo a tensión secundario a barotrauma. Presentación de un caso. Cirugía y Cirujanos 2015;83(5):429–432. DOI: 10.1016/j.circir.2015.05.046.
